Caring in Families: What Motivates Wives, Daughters

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Journal of Family Studies

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Caring in Families: What Motivates Wives, Daughters, and Daughters-in-law to Provide 1 Dementia Care? Suzanne M. Cahill To cite this article: Suzanne M. Cahill (1999) Caring in Families: What Motivates Wives, 1

Daughters, and Daughters-in-law to Provide Dementia Care? , Journal of Family Studies, 5:2, 235-247, DOI: 10.5172/jfs.5.2.235 To link to this article:

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Caring in Families: What Motivates Wives, Daughters, and Daughters-in-law to Provide Dementia Care?1

Suzanne M. Cahill School of Social Work and Social Policy, The University of Queensland

The literature provides convincing evidence that in western cultures most informal care is provided by wives and other female relatives. Yet in Australia, little empirical research has been collected on the topic o f why w o m e n adopt care roles. Drawing on qualitative data derived from in-depth interviews (N=39), this paper explores the diverse reasons behind why w o m e n adopt dementia care roles and the extent to which a choice is available to them. Some emerging differences between wives, daughters, and daughters-in-law regarding motivation to care are discussed. It is concluded that practitioners working in the field o f aged care need to be mindful o f the processes involved in decisions to care and o f the extent to which informal care may be provided either willingly or reluctantly.

Keywords: Caregiving; Dementia; Motivation

Estimates of the size of the caring phenomenon in Australia show that in 1993 there were 1.5 million carers looking after another person in the same household (Australian Bureau of Statistics [ABS], 1995). Over a half a million of these (541,000) were principal carers, who provided care to persons with a severe or profound handicap.Two-thirds of these principal carers were female (ABS, 1995). In Australia, as in most western industrialised societies, there is a large economic imperative driving the social encouragement of women into unpaid caregiving roles (Cahill & Shapiro, 1998; Shaver & Fine, 1996). Population ageing (Borowski & Hugo, 1997; Sax, 1993) together with federal government policies directed towards winding down institutional alternatives and restricting aged-care access to only the very frail aged (Gibson & Liu, 1995), are factors likely to result in even larger numbers of aged people requiring community care in future years. Yet little is known about 1. Correspondence and requests for reprints should be addressed to: Dr Suzanne Cahill, Director, Dementia Services Information and Development Centre, St James Hospital, James Street, Dublin, Ireland. Telephone 353 1 4162050; Fax: 353 1 4103482; Email [email protected]

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the processes involved in women adopting informal care roles in Australia. There is also a paucity of published literature about women's own interpretations of their situations as carers. Caregiving can reflect fear and obligation as well as affection and concern for others (Allan, 1988; Aronson, 1992), yet it is often assumed that care relationships evolve from warm and tender "caring about" relationships (Ungerson, 1987). To enable effective social care planning and the development of realistic aged-care policies, we need to understand more about how informal care emerges and the history and nature of these evolving relationships. We need to learn more from women themselves about what motivates them to care. This paper addresses six key research questions: (a) to what extent are the women in the sample satisfied with their pre-caring relationships?; (b) which of five factors (love, obligation, duty, commitment, and guilt) motivate these women to care?; (c) are there differences between spouses and non-spouses regarding reasons for caring?; (d) are there additional reasons why women become primary caregivers?; (e) who are the hypothetical carers and why do they not assume the role?; and (f) is there a choice available to women who become primary caregivers? The care relationships described in this research are those where women, either as wives, daughters, or daughters-in-law, were principal carers. In Australia, we know that in the over-60 aged group, looking after a spouse becomes the most common form of caregiving and men as spouse carers predominate (ABS, 1993), but in this research the focus was on women as principal carers. The care relationships described in the research are also those which evolved in the context of dementia management. Dementia care is different from other forms of care (Mace & Rabins, 1981). Unlike strokes or accidents, where effects can appear quite suddenly, the deterioration associated with dementia is generally progressive, and the care role generally unfolds gradually with care tasks often escalating until such time as caring becomes a 24-hour around-the-clock commitment (Cahill, 1997; Cahill & Shapiro, 1997; Graham, 1983). The issue of the 24-hour daily nature of dementia care leads to a specific set of questions for the care role and for carers. Literature R e v i e w The lack of attention to women's caregiving work across the lifespan began to shift during the 1980s when a group of British writers first introduced the feminist caregiving debate (Finch & Groves, 1980; Finch & Groves, 1983; Graham, 1983; Land & Rose, 1985; Lewis & Meredith, 1988; Pascal, 1986; Ungerson, 1983). In the earlier feminist debate, caring was shown to be predominantly a women's issue and the provision of care to an aged and frail family member was said to entail immense interpersonal sacrifice. The personal was political (Ungerson, 1987). Women's experiences as carers were shaped by their interactions with the labour market and


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with health and welfare agencies. Understanding caregiving entailed looking beyond the individual, towards sociopolitical structures. A central focus of these earlier works was on an exploration of the issue of why women cared (Guberman, 1992; Ungerson,1987). At a macro level, it was suggested that both material and ideological forces reinforced each other and largely determined why women entered care roles (Qureshi &Walker, 1989;Ungerson, 1987;Ungerson, 1995). Material forces referred to women's life cycle positions and their involvement in paid or unpaid work. Ideological forces were "the normative gendered kinship obligations" which existed in western society (Ungerson, 1987). Other writers noted that based on societal expectations (Finch & Mason, 1993), differences existed in feelings of commitment, responsibility, and compassion depending on whether a carer was a spouse or other family member (Cohler, Groves, Borden, & Lazarus, 1989; Opie, 1992). Care within marriage was generally regarded as an obvious extension of marriage (Oliver, 1983; Parker, 1993), whereas the normative expectation for children to give care was less absolute and more open to negotiation (Finch, 1989; Parker, 1993;Twigg & Aitkin, 1994, 1995). Some writers have questioned the extent to which caregiving could take place within relationships devoid of love and affection (Leira, 1994;Waerness, 1990). Leira, for example, made the point that "caring for" could be undertaken in the absence of"caring about", and that the obligation to care could transcend "affective justification" (Leira, p. 189). An interesting issue raised in this earlier discussion was whether family care was motivated by love or duty (Finch, 1989; Opie, 1992; Ungerson, 1987). Opie developed a useful typology and showed how motivation could move across several different planes including (a) commitment, (b) obligation, (c) dissociation, and (d) repudiation (p. 108). Opie viewed differences in motivation as important because of their implications for how ready the caregiver was to sustain the caring role. Committed carers, she argued, were most ready to sustain caregiving, while dissociated carers were more likely to have considered relinquishing the care role. The extent to which care roles may be motivated by love or duty is an issue which will be investigated in this research. The women's perceptions of the quality of their pre-dementia caring relationships will also be explored.

Method The study comprised a descriptive exploratory investigation of female caregivers living in Brisbane, Queensland. The study's design reflected the exploratory nature of the research and enabled the collection of qualitative data. In-depth interviews were conducted with 39 female carers of persons diagnosed with Alzheimer's Disease or a related dementia. The sample was recruited with the assistance of (a) aged care

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assessment teams, (b) the Alzheimer's Association of Queensland, (c) community health, and the (d) domiciliary nursing services. This direct recruitment of carers through professionals is said to be one of the most widely used methods for obtaining samples for caregiving studies (Biegel & Blum, 1990). However one limitation of the study's design is the biased nature of the sample, since participants were restricted to carers already in touch with service providers. Apart from in-depth interviews, data were also collected by means of a semi-structured questionnaire. The questionnaire contained fixed-choice and open-ended questions. Each interview was audiotaped and later transcribed. A model for analysing qualitative data which includes data reduction, data display, and conclusion drawing/ verification was carefully followed (Miles & Huberman, 1994). First data from taped interviews were grouped. The main strategy used for data reduction was that of grouping together responses according to particular themes, and conducting within-case and cross-case analysis. The within-case analysis sought to link data with explanations and tried to understand why the phenomena occurred as they did. The cross-case analysis was then conducted between multiple cases, grouping together answers from different people to common questions. Strategies used for data reduction included counting, noting patterns and themes, and linking solicited and unsolicited data. In this way, each taped interview was coded, simplified, and abstracted and various themes were extricated. Themes or patterns noted included the women's commitment to long-term marriages and to family relationships, and their reasons for becoming a primary caregiver. Secondly, data were displayed. When responses to all open-ended questions were written out a code book was developed, and data derived from questions along with other unsolicited data collected by audiotape were displayed. Designing the display and deciding which data were appropriate for which cell became part of the analysis. The final matrix resulted in a large amount of data becoming immediately accessible in a user-friendly, compact form. One technique used to facilitate the development of this data matrix was clustering; for example, the grouping together of cases with earlier unsatisfactory or abusive pre-caring relationships. Thirdly, data verification was undertaken and conclusions were drawn. The meanings emerging from the data were tested for their plausibility and validity against data collected from the fixed choice questions. In this stage of the qualitative analysis, peer review was undertaken to ensure an inter-subjective consensus and to enable plausible conclusions to be drawn. The qualitative data which emerged from the interviews provided detail and context. The data tended to relate to how carers felt about their roles and relationships. A focus on respondents' own words, individual experiences, and their personal interpretations greatly enhanced an understanding of their motivation to care.


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Results The Demographic Profile of Carers Participants were either wives (n=24), daughters (n=12), or daughters-in-law (n=3) of persons diagnosed with dementia. Although several had prior experience as principal carers (since their spouses or parents suffered from other health conditions apart from dementia), each had been providing dementia care for an average period of three and a half years. In the main, participants were an elderly cohort. Two thirds were more than 60 years old: their ages ranged from 35 to 85 years (mean age = 64). In keeping with national data on caregivers (ABS, 1995), the majority (n=35) were co-resident with their relative at the time of interview and most lived in "couple-only" relationships (n=24), having been partners in long-term marriages. In several cases, participants were "women in the middle" caring for spouses, children, and parent(s).The majority had a limited education and most had little recent paid-work experience. Two thirds reported they were housewives prior to their acquiring dementia care roles. Six women had stopped paid work to care. Pre-Caring Relationship History The women were interviewed about the quality of their earlier marital relationships and past family life. To provide some context for a discussion of long-term relationships, a specific question was asked: "How satisfied were you with your relationship before your relative or spouse developed dementia?".While most (87%) reported they were either satisfied or very satisfied with their earlier relationships, a small minority (two wives and three daughters) claimed they were dissatisfied. Table 1 — Respondents' Satisfaction with Pre-morbid Relationship (N=39)

Level of satisfaction Very satisfied Satisfied Dissatisfied Very Dissatisfied Total

N 18 16 2 3 39

% 46 41 5 8 100

It seems that for some of these women, caring in the absence of a warm, loving relationship was very difficult: I mean to say — if you love them and that — you'll give them all your care but I think that was finished with us after all he had done to me. (Spouse carer) I had a very hard life with him and over the years it [the relationship] just dwindled. (Spouse carer)

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The comments reflect a theme frequently highlighted in the literature about how caring is embedded in pre-existing relationships; how feelings for family members are constructed within an historical context, and how the history of marriages has a considerable bearing on how successfully (or unsuccessfully) they are turned into caring relationships (Morris, Morris, & Britton, 1988; Motenko, 1989). Participants were also asked to report whether they had been victims of any form of aggression or abuse (physical, verbal, and sexual) directed at them by their spouses or parents before the onset of the dementia. A total of 11 out of the 39 participants (28%) reported that aggression or abuse had existed in their earlier pre-morbid relationships. In one case, the abuse was verbal, physical, and sexual. In another, abuse started in pregnancy and continued throughout the carer's marriage, intensifying with her husband's Korsakoff's Disease. Further analysis revealed that 8 out of the 11 participants who had experienced earlier abuse reported they were satisfied with their relationships. The higher level of satisfaction than might be expected in the context of abusive or aggressive relationships could suggest something further about how this subgroup of women may have been prepared to neglect their own self-interests. The findings suggest that abuse within these relationships did not necessarily lead to reported dissatisfaction. Reasons for Caregiving To help the women focus on a discussion about motivation and caregiving, a series of questions was asked. First, five factors known to be associated with motivation to care, namely love, concern, duty, moral obligation, and guilt (Allan, 1988;Aronson, 1992; Ungerson, 1987) were read out to participants, who were asked to identify which of these factors motivated them most. Table 2 — Reasons Selected by Respondents for Caregiving* (N=39) Reasons Concern Love Duty Obligation Guilt

N 37 36 29 19

% 95 92 74 49



* Responses were not mutually exclusive

Table 2 shows how a large majority of participants cited concern (95%), love (92%), and duty (74%) as factors relevant to decision-making. Approximately half of the women reported that moral obligation influenced the decision. A small minority (mostly those who claimed they had been victims of earlier abuse or aggression) identified guilt as a motivating force. For most participants, caregiving


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was grounded in commitments arising from long-term marriages ("We've been married 50 years so naturally you take care"), and in gendered kinship obligations, ("She was my mother, I could never have done it for anyone else"), but in a small minority of cases (n=3), the obligation to care was removed from love and affection, as revealed by the women's testimonies: "I don't know about the word love, but you do the right thing". The extracts reflect the power of ideology to determine care roles, even in the absence of love or affection. Participants were asked if there were any other reasons why they cared. Half (n=20) identified additional reasons. Analysis of these texts yielded two broad categories of responses: (a) participants who cared because they wanted to, or because they considered themselves the natural person to undertake the role (n=11); and (b) those who cared because they felt they had to care or because there was nobody else willing or available (n=9). Further analysis of these two sets of responses revealed clear distinctions between spouses and non-spouses. Among those who wanted to care, all but one were spouses, while among those who felt they had to care, six out of nine were daughters. It seems that for some wives, a long and fulfilling marriage, including a history of a shared past and a commitment to a shared future, created a powerful and overarching obligation: We've been married 51 years you know; it's a long time. He looked after me and why shouldn't I look after him? We were just a married couple. (Spouse carer) I felt it was my place to look after him. We've been together for so long, for 43 years, so I mean I felt I had to keep on going for as long as I possibly could and I did you know. (Spouse carer) I just cared for him. I didn't even question it. He was my husband. We'd been married 50 years. I preferred to do it myself because I knew his little ways and idiosyncrasies. (Spouse carer)

Their comments contrast sharply with the daughter and daughter-in-law carers: I suppose you could have said no you could have been nasty, but she needed somebody. (Daughterin-law carer) Duty had a lot to do with it. She had nobody eke. She made me her next of kin without consulting me. (Daughter carer) Basically it had to be done and there was no choice. (Daughter carer)

To further explore the question of motivation, participants were asked "Who else could have become a primary caregiver and why did they not?".Table 3 shows participants' views of hypothetical alternative carers and the reasons why they remained exempt from the role. Only 11 women (28%), identified possible carers within their kinship system. Seven of these eleven were non-spouses. Data analysis revealed that in participants' views, structural factors such as gender, marital status,

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and positions in either paid employment or other caring work precluded these other family members from adopting care roles. Closer investigation of the data revealed that the majority of women who nominated alternate carers were daughters, and in virtually every case proximity of kinship (particularly female kinship) seemed the major determining factor. This pattern of females being identified as alternate carers was also evident in spouses' responses to the same question, although here it was not nearly as marked. Finally, participants were asked the question: "Was there a choice available to you to become the primary caregiver?". Only three women (two daughters and a wife) acknowledged they had a choice. Interestingly, the older wives had considerable difficulty with this question and most asked for its clarification. A typical response was: "What do you mean, I'm his wife?". It seems that for many of the older

Table 3 — Perceptions of Who Could Have Provided Care But Did Not (n=39) Married daughter

Some of her relatives could have done it. Possibly my brother at a pinch, but my brother's wife couldn't have copes with her at all and my brother is away a lot.

Married daughter

My sister, but she has a big family and there's been a big family dispute and she has never got in touch with mother since.

Married daughter

My sister, but she doesn't even visit.

Married daughter

One of my sisters but one is an alcoholic and the other has six children.

Divorced daughter

My sister but she works.

Never married daughter

My sister but they had financial troubles. Her husband would not agree whereas I was on my own and single.

Widowed daughter

One of her family but they were not available.


No, there was really only my daughter but she was working.


Robert, my son, well he'd run 20 miles because he can't stand to see his father the way he is.


Nobody really because my son and his wife, they both work and I only have one son and my husband doesn't have any sisters.


I only have one daughter and she has children and she couldn't have coped.


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spouses, caring was so deeply embedded in their values and beliefs that posing a question of this nature in itself seemed somewhat redundant. In contrast the question made a lot of sense to daughters and daughters-in-law Like the wives, but for different reasons, the vast majority of daughters and daughters-in-law reported they had no choice but to care.

Discussion The study is a first attempt to open up the Australian debate on the issue of what motivates women to care for their aged and confused spouses, parents, and parentsin-law. The research combined carers' narratives with data emerging from fixedchoice questions. Results demonstrated the complex forces which acted on female family members, resulting in some women rather than others adopting principal care roles. Findings revealed how women's individual descriptions of their roles and responsibilities — along with the broader forces (beyond the women's specific worlds) which shaped their patterns of thinking — provided them with a strong injunction to care. The data revealed that decisions about caregiving may be impacted upon by a whole range of inter-connecting factors, including love, concern, duty, guilt, reciprocity, gender, life cycle positions, and material circumstances. Regarding the fixed-choice questions, three distinct factors emerged as important forces influencing the decision to care: love, concern, and duty. Interestingly, responses to the open-ended questions expanded on data yielded by the fixed-choice approach and enabled the identification of some emerging trends between spouses and non-spouses. Wives appeared to want to care in order to comply with marriage obligations. Daughters and daughters-in-law, on the other hand, were more likely to feel they had to care, and several inadvertently pointed to the inescapable moral obligations which members of kinship groups experience to love and support family members. It seems that reasons for caring were more complex for daughters and daughters-in-law than for spouses, and extended beyond pure altruism, commitment, and intergenerational reciprocity. Their motivation seemed shaped by several different structural and contextual constraints including gender, labour market positioning, the availability of others within the kinship network, and commitment to other family care responsibilities. These findings highlight the benefit of a qualitative approach in an exploratory study of this sort. While the fixed-choice questions helped the women to focus and to think carefully about their roles and relationships, the open-ended questions facilitated an extension and expansion of carers' testimonies, and provided a more comprehensive understanding of both the carers' individual worlds and the societal constraints which acted as forces upon them. In this way, the narrative data provided depth and meaning and enriched the findings.

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Although only preliminary, the study's findings challenge the notion that families are altruistic units, a particularly pervasive phenomenon especially in social policy literature (Finch, 1989). Results show that women's roles, their relationships with their relatives, and their commitments to care for family members stem from past histories, some of which are not always positive or satisfying. A small proportion of participants in this study reported that they provided care because they had no option, and because nobody else was willing or available. There were others who, despite what appeared to be distant and at times hostile relationships, provided extensive care to husbands, parents, and parents-in-law. The findings confirm other published research which demonstrates that caregiving can and does take place in the absence of love and affection, and that the obligation to care may transcend "affective justification" (Leira, 1994). The findings support the view that within the family a darker side of manipulative dependency can exist (Qureshi & Walker, 1989).

Conclusions The results from this work have important practice and policy implications for those working in the area of aged care. Findings suggest that in attempting to develop and deliver services for older people, policy-makers and practitioners need to be mindful of the processes which lead women into adopting primary care roles. Medical practitioners, professionals on aged care assessment teams, and other service providers working in the aged-care field should listen carefully to carers' own interpretations of their situations, to gain insights into the reasons why they care. When care is given reluctantly and unwillingly, practitioners should be conscious of the quality of care being offered and of the potential for neglect and elder abuse. Practitioners need to monitor carefully these types of home-care arrangements. More flexible and generously funded social services need to be offered. In the early stages of dementia, community aged-care packages may help free some of these reluctant carers from the strong moral obligation to provide care. Policy changes such as longer hours of day-care, more flexible labour market arrangements to facilitate carers who wish to work while continuing to care, and increased support for carers, including night time, week-end, and recreational leave, need to be introduced. Women who quit work to care also require special consideration. The economic cost of caregiving for those who would otherwise be gainfully employed needs careful acknowledgment and, in particular, governments need to place a more realistic dollar value on caregiving work. Australia has much to learn from Scandinavian countries where population ageing has already been witnessed, and where well-developed income maintenance policies for informal caregiving have been in existence now for several years (Glendinning, Schunk, & McLoughlin, 1997). It must also be kept in mind that family relationships may change over time,


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Caring in Families and managing a dementing illness in a partner, parent, or parent-in-law may well result in the erosion of what was formerly a very caring, loving relationship. Finally, the different reasons for caring provided by spouses, daughters, and daughters-in-law suggest the need for future caregiving research. Results showed that wives were more likely to want to care, while daughters and daughters-in-law in general cared because of kinship obligations and because nobody else was willing or available to do so. One explanation for the differences noted may be that for daughters, kinship obligations are far less binding than are the commitments to care which arise from long-term marriages, and many "women in the middle" have competing responsibilities (Brody, 1990). In the United Kingdom, the notion that kinship obligations to care appear to be getting looser as a result of women's labour market positions, geographical shifts, and changes in family composition has already been noted (Ungerson, 1995). However it needs to be remembered that we may already be seeing changes in the socialisation process and in younger women's attitudes to the practice of unpaid care. If the difference between the two cohorts has arisen due to a changing ideology, findings may well signal a significant change in future care practice. The question of whether younger cohorts of women will, as they themselves age, be less inclined to provide unpaid care services needs to be further investigated. Prospective studies which use large random samples of carers and which document women's attitudes to both spouse and parental care now need to be undertaken. In order to plan older peoples' future care services, we need to know more about women's future availability and willingness to care. Acknowledgments: The author would like to thank Dr Margaret Shapiro, Director of Post-Graduate Studies at the School of Social Work and Social Policy, for her very valuable advice and comments on earlier drafts of this paper. Thanks are also extended to all of the female caregivers who participated in the research, to the service providers who assisted in recruiting the sample, and to the anonymous reviewers of this article for their very helpful suggestions.

References Allan, G. (1988). Kinship responsibility and caring for the elderly. Ageing & Society, 8, 249-268. Aronson, J . (1992). Women's sense of responsibility for the care of older people: But who else is going to do it? Gender & Society, 6, 8-29. Australian Bureau of Statistics (1993). Disability, ageing and carers: Summary of Findings. (Catalogue No. 4430.0). Canberra: Commonwealth Government Printer. Australian Bureau of Statistics (1995). Focus on families: Caring in families, support for persons who are older or have disabilities. (Catalogue No.4423.0). Canberra: Commonwealth Government Printer. Biegel, D., & Blum, A. (1990). Ageing and caregiving: Theory research and policy. Newbury Park: Sage.

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Suzanne M. Cahill Borowski, A., & Hugo, G. (1997). Demographic trends and social policy. In A. Borowski, S. Enkel, & E. Ozanne (Eds.), Ageing and social policy in Australia (pp. 19-52). Cambridge: Cambridge University Press. Brody,E. (1990). Women in the middle: Their parent care years. New York: Springer. Cahill, S. (1997). I wish I could have hung on longer: Choices and dilemmas in dementia care. Unpublished doctoral dissertation, The University of Queensland, Brisbane. Cahill, S., & Shapiro, M. (1997)."At first I thought it was age": Family members' recognition and general practitioners' diagnosis of dementia. New Doctor, 67, 19-23. Cahill, S., & Shapiro, M. (1998). The only one you neglect is yourself: Health outcomes for carers of spouses or parents with dementia: Do wives and daughter carers differ? Journal of Family Studies, 4, 87-101. Cohler, B., Groves, L., Borden, W., & Lazarus, L. (1989). Caring for family members with Alzheimer's Disease. In E. Light & B. Lebowitz (Eds.), Alzheimer's disease treatment and family stress: Directions for research (pp. 245-266). Washington, DC: U.S. Department of Health and Human Services. Finch, J. (1989). Family obligations and social change. Cambridge: Polity Press. Finch, J., & Groves, J. (1980). Community care and the family: A case for equal opportunities. Journal of Social Policy, 9, 487-511. Finch, J., & Groves, J. (1983). A labour of love: Women work and caring. London: Routledge & Kegan Paul. Finch, J., & Mason, J. (1993). Negotiating family responsibilities. London: Roudedge. Gibson, D , & Liu, Z. (1995). Planning ratios and population growth: Will there be a shortfall in residential aged care by 2021? Australian Journal on Ageing, 14, 57-62. Glendinning, C , Schunk, M., & McLaughlin, E. (1997). Paying for long-term domiciliary care: A comparative perspective. Ageing and Society, 17, 123-140. Graham, H. (1983). Caring: labour of love. In J. Finch & D. Groves, (Eds.), A labour of love: women, work and caring (pp. 13-31). London: Roudedge & Kegan Paul. Guberman, N. (1992). Women as family caregivers:Why do they care? The Gerontologist, 32, 607-617. Land, H., & Rose, H. (1985). Compulsory altruism for some or an altruistic society for all. In P. Bean, F. Ferris, & D. Whynes (Eds.), In defence of welfare (pp. 74-96). London: Tavistock. Leira, A. (1994). Concepts of caring: Loving, thinking and doing. Social Science Review 0,185-201. Lewis, J., & Meredith, B. (1988). Daughters who care: Daughters caring for mothers at home. London: Rutledge & Kegan Paul. Mace, N. L., & Rabins,P.V.(1981). The thirty six-hour day: A family guide to caring for persons with Alzheimer's Disease, related dementing illnesses and memory loss in later life. New York: John Hopkins University Press. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook. Newbury Park: Sage.


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Caring in Families Morris, L., Morris, R., & Britton, P. (1988). The relationship between marital intimacy, perceived strain and depression in spouse caregivers of dementia sufferers. British Journal of Medical Psychology, 61, 231-236. Motenko, A. (1989). The frustrations, gratifications and well-being of dementia caregivers. The Gerontologist, 29, 166-172. Oliver, J. (1983). The caring wife. In J. Finch & D. Groves (Eds.), A labour of love: Women work and caring (pp. 72-88). London; Routledge & Kegan Paul. Opie,A. (1992). There's nobody there. Community care of the confused older person. Auckland, NZ: Oxford University Press. Parker, G. (1993). With this body: Caring and disability in marriage. Buckingham: Open University Press. Pascal, G. (1986). Social Policy; A feminist analysis. London and New York: Tavistock. Pruchno, R., & Resch, N. (1989). Husbands and wives as caregivers: Antecedents of depression and burden. The Gerontologist, 29, 159-165. Qureshi, H, & Walker, Q. (1986). Caring for the elderly: The family and the state. In C, Philipson & A.Walker, (fids.), Ageing and social policy: A critical assessment (pp. 109127). London: Gower. Qureshi, H., & Walker, A. (1989). The caring relationship: Elderly people and theirfamilies. Philadelphia. Temple University Press Sax, S. (1993). Ageing and public policy in Australia. Sydney: Allen & Unwin. Shaver, S., & Fine, M. (1996). Social policy and personal life: Changes in state, family and community in the support of informal care. In Aged and community Care Division and Office of Disability, Department of Human Services and Health (Eds.), Towards A National Agenda for Carers: Workshop papers (pp. 19-36). Canberra: Australian Government Printing Service. Twigg, J., & Aitkin, K. (1994). Carers perceived: Policy and practice in informal care. Open University Press / Milton Keynes. Twigg, J., & Aitkin, K. (1995). Carers and services: Factors mediating service provision Journal of Social Policy, 24, 5-30. Ungerson, C. (1983). Why do women care? In J. Finch & D. Groves (Eds.), Caring a labour of love. London: Routledge & Kegan Paul. Ungerson, C. (1987). Policy is personal: Sex gender and informal care. London: Tavistock. Ungerson, C. (1995). Gender, cash and informal care: European perspectives and dilemmas.Journalof Social Policy, 24, 31-52. Waerness, K. (1990). Informal and formal care in old age: What is wrong with the new ideology in Scandinavia today? In C. Ungerson (Eds.), Gender and caring: Work and welfare in Britain and Scandinavia (pp. 110-132.). London: Harvester Wheatsheaf.

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